Part 4 - Iowa Medicaid Enterprise

RFP MED-12-001 | Technical ProposalIowa Medicaid Enterprise System Service Procurement | MMIS and Core MMIS OperationsFigure 9.1.3.1-4. eCAMS Screen Showing Links to Upload an EDI HIPAA File. By providing a linkto upload an EDI file in eCAMS, Team Noridian’s solution provides better customer service toDepartment's providers.The paper forms received in the mailroom and via fax are scanned and converted into an electronic dataformat. An overview of the paper claims and adjustments intake process volume is shown in Figure9.1.3.1-5. Emdeon Transform classifies and batches the scanned images and processes the documentthrough optical character recognition (OCR) to produce the claim text in an electronic format. OCRfalling below the defined threshold is manually keyed. The electronic claim text file (which is in IRLformat) is then sent to EDI Services. The image of the actual paper claim or any claim attachments isloaded in the OnBase repository. Authorized users can access claim attachments while viewing the claimsin eCAMS screens through the Claims Retrieval screen. Team Noridian’s solution accepts electronic andhard copy attachments. Emdeon Transform is used for converting the hard-copy claims and attachmentsto images, which are stored in the OnBase repository. Attachments are linked to the original claims usingattachment control numbers and are retrieved through eCAMS screens. eCAMS allows for edit processingto consider the existence of attachments sent by the submitter as part of the business rule. When an editdetermines that the service requires additional documentation and the claim does not indicate thedocumentation has been sent, the system will automatically send an online tickler to the billing provider’sinbox notifying the provider of the need for additional information in order to process the claim. Thisnotice will appear the next time the provider logs into eCAMS screens. The system will automaticallygenerate letters for the non-electronic community of providers. The claim being adjudicated will berecycled each day, based on user configurable time periods established on the error table, until either it isable to identify that the attachment was received or the time period established for the claim recycle hasbeen met. If the attachment is available, the claim is suspended for manual review of the attachment. Ifthe attachment has not been received, the disposition of the claim will be set to deny.9.1.3.1 | 10